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The histological changes in the liver, kidney, spleen, and gills of Syacium papillosum from the continental shelf of the Yucatan Peninsula, Gulf of Mexico, and their statistical associations with environmental conditions and pollutants were assessed in 2010, 2011, and 2012. We evaluated the extension and severity of the lesions through a degree of tissue change (DTC), and, with the sum of the number of lesion types within each of their DTC stages, we determined the histological alteration index (HAI). The liver and kidney were the most affected organs, with HAI values > 100. Fish with the most severe damage were observed on the Campeche Bank and the Caribbean Sea, contrasting with those collected from the northern Yucatan continental shelf. The presence of foci cellular alteration and abundant melanomacrophage centers indicated that these flatfishes were chronically exposed to environmental stress factors. Redundancy analyses showed strong associations between HAI values and hydrocarbon and heavy metal concentrations in muscle. Our results provide evidence for the first time of a differential health condition of the Yucatan shelf through the histopathology shown in S. papillosum, establishing the baseline for future monitoring programs in the region.

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The GSTRIDE database contains information of the health status assessment of 163 elderly adults. We provide socio-demographic data, functional and frailty variables, and the outcomes from tests commonly performed for the evaluation of elder people. The database contains gait parameters estimated from the measurements of an Inertial Measurement Unit (IMU) placed on the foot of volunteers. These parameters include the total walking distance, the number of strides and multiple spatio-temporal gait parameters, such as stride length, stride time, speed, foot angles and clearance, among others. The main processed database is stored, apart from MS Excel, in CSV format to ensure their usability. The database is complemented with the raw IMU recordings in TXT format, in order to let researchers test other algorithms of gait analysis. We include the Python programming codes as a base to reproduce or modify them. The database stores data to study the frailty-related parameters that distinguish faller and non-faller populations, and analyze the gait-related parameters in the frail subjects, which are essential topics for the elderly.

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BACKGROUND: Our objective is to describe the presentation and complications, including relapses, of coronavirus disease 2019 (COVID-19) in patients under anti-CD20 treatments. In addition, to describe viral clearance and determine the safety of reintroducing anti-CD20 treatment. METHODS: Retrospective cohort study of 422 patients under anti-CD20 treatment that was administered from 1 January 2019 to 31 December 2020. RESULTS: Fifty-seven patients were diagnosed with COVID-19 (13.5%). Twenty-five patients (43.9%) required hospital admission. Five patients died (8.8%), and 10 developed severe COVID-19 and acute respiratory distress syndrome. Mortality rate was higher among patients infected during the first 3 months following the last dose of anti-CD20 (14.7% vs 0%, P = .046). The median time of persistence of positive reverse transcription polymerase chain reaction (RT-PCR) was 22 days (IQR 13-40).Nine out of 52 survivors (17.3%) presented relapses. All of them received the last dose of anti-CD20 less than 6 months before the COVID-19 episode. Clinical presentation was fever (n = 8; 88.9%), dyspnea (n = 7; 77.8%), cough (n = 7; 77.8%), worsening of previous infiltrates (n = 5; 55.6%) and new pulmonary infiltrates (n = 8; 88.9%). An increase in lymphocytes with CD4/CD8 ratio inversion was observed in all cases. Among the 25 patients who resumed anti-CD20 drug, 4 (16.0%) presented relapses vs 5/28 among those who did not (17.9%), (P = .857). CONCLUSIONS: Patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the 6 months after anti-CD20 administration had a worse outcome and a higher mortality rate. The duration of infectivity may be longer. Relapses of COVID-19 occurred in more than 15% and were associated with viral replication. Once the infection is resolved, it is safe to restart treatment with anti-CD20.

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The regulation of chromatin biology ultimately depends on the manipulation of its smallest subunit, the nucleosome. The proteins that bind and operate on the nucleosome do so, while their substrate is part of a polymer embedded in the dense nuclear environment. Their molecular interactions must in some way be tuned to deal with this complexity. Due to the rapid increase in the number of high-resolution structures of nucleosome-protein complexes and the increasing understanding of the cellular chromatin structure, it is starting to become clearer how chromatin factors operate in this complex environment. In this review, we analyze the current literature on the interplay between nucleosome-protein interactions and higher-order chromatin structure. We examine in what way nucleosomes-protein interactions can affect and can be affected by chromatin organization at the oligonucleosomal level. In addition, we review the characteristics of nucleosome-protein interactions that can cause phase separation of chromatin. Throughout, we hope to illustrate the exciting challenges in characterizing nucleosome-protein interactions beyond the nucleosome.

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The objective of this study was to evaluate the histopathological alterations in juvenile Penaeus vannamei caused by silver nanoparticles (AgNPs) for two types of experiments: at sublethal concentrations of 3.6 to 7.1 µg/µL of metallic silver (Ag) for a short period up to 72 h and for 2.6 to 7.9 µg of Ag/µL for the long period up to 264 h. The severity degree of the changes was evaluated and the histopathological index (Hi) was determined in both experiments using the necrosis (cellular dead) as an indicator. The pathological changes in the striated muscle, gills, antennal gland, circulatory system, heart, lymphoid organ, and connective tissue are described. The histopathological effects were similar for the two experiments without a direct relationship with the concentrations. In the short-term experiment, the values of Hi were higher (2.34 ± 0.41 at 48 hpi and 1.91 ± 0.39 at 72 hpi) compared with the long-term experiment (values between 0.57 ± 0.36 to 1.74 ± 0.57 at 264 hpi). The observed pathologies are similar to those caused by other metals, with the exception of the agglomerations of black particles in the gills, lymphoid organ, and muscle, which has not been previously reported. This work shows that silver nanoparticles cause damage to shrimp in sublethal concentrations.

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Monogeneans are a diverse group of parasites that are commonly found on fish. Some monogenean species are highly pathogenic to cultured fish. The present study aimed to determine the in vitro anthelmintic effect of silver nanoparticles (AgNPs) against adults and eggs of monogeneans in freshwater using Cichlidogyrus spp. as a model organism. We tested two types of AgNPs with different synthesis methodologies and size diameters: ARGOVIT (35 nm) and UTSA (1-3 nm) nanoparticles. Damage to the parasite tegument was observed by scanning electron microscopy. UTSA AgNPs were more effective than ARGOVIT; in both cases, there was a concentration-dependent effect. A concentration of 36 µg/L UTSA AgNPs for 1 h was 100% effective against eggs and adult parasites, causing swelling, loss of corrugations, and disruption of the parasite's tegument. This is an interesting result considering that monogenean eggs are typically tolerant to antiparasite drugs and chemical agents. To the best of our knowledge, no previous reports have assessed the effect of AgNPs on any metazoan parasites of fish. Therefore, the present work provides a basis for future research on the control of fish parasite diseases.

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BACKGROUND: Homeopathy has been widely applied in freshwater species but rarely in marine fish. Farm stress destabilises host-pathogen equilibrium, favouring parasites and disease. Coccidian endoparasites cause intestinal infections and cell degeneration. MATERIALS AND METHODS: Naturally parasite-infested juvenile snapper Lutjanus guttatus (n = 430; weight 1.9 ± 0.01 g; length 4.9 ± 0.03 cm) specimens were distributed in group sizes of 43, in 10 fiberglass tanks (100 L) with aeration and continuous water change. Five groups in duplicate were assessed: Passival (PaV); Passival and Phosphoricum acid Similia (PaV-PhA); Passival and Silicea terra Similia (PaV-SiT); Endecto and Infecçoes (End-Inf) and a control (Ethanol) for 45 days. Feed was sprinkled with treatment (5% v/w) and dried to avoid ethanol side-effects. Statistical results were expressed as mean ± standard error of the mean. RESULTS: Intestinal coccidia were recorded histopathologically, with the least incidence attained at T45 with End-Inf treatment (p < 0.001), coinciding with the highest lymphocyte (p = 0.015) count. Fish treated with PaV-PhA recorded a higher percentage of neutrophils (p = 0.015), and those treated with PaV-PhA, PaV-SiT and End-Inf revealed a decrease in lesions, degree of alteration and change in intestine and stomach tissues (p < 0.05). The number of mucous cells in gills was greater (p < 0.001) for End-Inf (43 ± 0.58), PaV-SiT (40 ± 2.89) and PaV-PhA (39 ± 3.46) as compared respectively with T0 and control (19 ± 0.58 and 28 ± 2.31). PaV and PaV-SiT increased carbohydrate reserves in liver (28.4 ± 1.39% and 22.4 ± 0.12%, respectively) compared with T0 and control (3.4 ± 0.32 and 5.6 ± 0.66%). The highest survival rate was 97.7 ± 0.16% in fish treated with PaV and End-Inf. CONCLUSION: Homeopathic treatments had a positive effect on fish health. Besides the accumulation of metabolic reserves in the liver, homeopathic treatment was associated with mucin increase in gills as well as raised production of lymphocytes and neutrophils in blood, which could act as macrophages against intestinal coccidia.

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This quantitative risk assessment provided an analytical framework to estimate white spot syndrome virus (WSSV) transmission risks in the following different scenarios: (1) partial harvest from rearing ponds and (2) post-harvest transportation, assuming that the introduction of contaminated water with viral particles into shrimp culture ponds is the main source of viral transmission risk. Probabilities of infecting shrimp with waterborne WSSV were obtained by approaching the functional form that best fits (likelihood ratio test) published data on the dose-response relationship for WSSV orally inoculated through water into shrimp. Expert opinion defined the ranges for the following uncertain factors: (1) the concentrations of WSSV in the water spilled from the vehicles transporting the infected shrimp, (2) the total volume of these spills, and (3) the dilution into culture ponds. Multiple scenarios were analysed, starting with a viral load (VL) of 1×102mL-1 in the contaminated water spilled that reached the culture pond, whose probability of infection of an individual shrimp (Pi) was negligible (1.7×10-7). Increasing the VL to 1×104.5mL-1 and 1×107mL-1 yielded results into very low (Pi=5.3×10-5) and high risk (Pi=1.6×10-2) categories, respectively. Furthermore, different pond stocking density (SD) scenarios (20 and 30 post-larvae [PL]/m2) were evaluated, and the probability of infection of at least one out of the total number of shrimp exposed (PN) was derived; for the scenarios with a low VL (1×102mL-1), the PN remained at a negligible risk level (PN, 2.4×10-7 to 1.8×10-6). For most of the scenarios with the moderate VL (1×104.5mL-1), the PN scaled up to a low risk category (PN, 1.1×10-4 to 5.6×10-4), whereas for the scenarios with a high VL (1×107mL-1), the risk levels were high (PN, 2.3×10-2 to 3.5×10-2) or very high (PN, 1.1×10-1 to 1.6×10-1) depending on the volume of contaminated water spilled in the culture pond (VCWSCP, 4 or 20L). In the sensitivity analysis, for a SD of 30 PL/m2, it was shown that starting with a VL of 1×105mL-1 and a VCWSCP of 12L, the PN was moderate (1.05×10-3). This was the threshold for greater risks, given the increase in either the VCWSCP or VL. These findings supported recommendations to prevent WSSV spread through more controlled transportation and partial harvesting practices.

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INTRODUCTION: The objective of the present study is to assess the safety and feasibility of the use of telemedicine-based services for surgical wound care and to measure patient satisfaction with telemedicine-based follow-up. MATERIAL AND METHODS: 24 patients were included, they were provided with a corporate mail address. On day 7 after surgery patients sent, via email, an image of their surgical wound together with a completed questionnaire in order to obtain an early diagnosis. Two independent physicians studied this information and the histologic analysis of the specimen. On day 8, all patients underwent face-to-face office examination by a third physician and all of them completed a satisfaction questionnaire at the end of the study. RESULTS: The use of telemedicine-based services showed a sensitivity of 100%, a specificity of 91.6%, a positive predictive value of 75% and a negative predictive value of 100%. Degree of concordance between the two physicians, as regards the necessity of face-to-face follow-up yielded a kappa coefficient of 0.42 (standard error 0.25 and confidence interval 95% (0.92-0.08), which means a moderate agreement between the two evaluations. 94% of patients were satisfied with telemedicine-based follow-up and 93% showed their preference for this procedure over conventional methods. CONCLUSIONS: The telemedicine-based follow-up, has proven to be feasible and safe for the evaluation of early postoperative complications. Patients reported high levels of satisfaction with the procedure. Telemedicine-based follow-up could become standard practice with the development of a specific mobile application.

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El dolor de cadera es una causa frecuente de consulta médica en la clínica diaria. Entre las diferentes causas que entran en el diagnóstico diferencial está el síndrome de pinzamiento isquiofemoral, que se describió inicialmente en pacientes tras cirugía de recambio articular, pero que a posteriori se ha descrito en pacientes sin antecedente de patología causal(AU)

Hip pain is a frequent cause of medical attention in the daily clinical practice. Among the different causes included in the differential diagnosis we find ischiofemoral impingement, described initially in patients after joint replacement surgery, but later found in patients with no history of a causal disease(AU)

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Hip pain is a frequent cause of medical attention in the daily clinical practice. Among the different causes included in the differential diagnosis we find ischiofemoral impingement, described initially in patients after joint replacement surgery, but later found in patients with no history of a causal disease.

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Over the last decade, new hospitals are integrating Information and Communication Technologies (ICTs) in their facilities. Although e-health is a relatively recent term for healthcare practice supported by electronic processes, ubiquitous healthcare monitoring, also known as m-health, is already an emerging research area. Patient monitoring in diverse environments, such as nursing homes or assisted living, are gaining importance. Traditional methods present some problems, as they don't allow enough patient mobility. In this situation, real time transmission of multiple medical data, wearable computing, wireless access in ubiquitous systems and wearable devices for pervasive healthcare can meet the needs of these environments. However, the software and infrastructure deployed in hospitals is not easy to migrate to wireless systems. In some cases, the migration to new technologies can be costly. This paper focuses on the design of a modular, scalable and economical framework to improve the monitoring and checking of patients in different contexts. The challenge is to produce a system to transmit the patient's biomedical data directly to a hospital for monitoring or diagnosis using new communication modules. The modular designed adopted is intended to provide a future-proofed system, whose functionality may be upgraded by modifying the hardware or software. The modules have been validated in different contexts to prove their versatility.

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La lesión de Dieulafoy es una causa importante pero infrecuente de hemorragia gastrointestinal. Se ha descrito a nivel gástrico y menos frecuente en duodeno, yeyuno y colon. Macroscópicamente es una malformación arterial, con tortuosidad y elongación del vaso, que aparece como un pequeño defecto de la mucosa e histológicamente son vasos largos que envuelven la submucosa y están por debajo de la mucosa. Tiene una incidencia del 0,3-1,5 por ciento como causa de sangrado gastrointestinal masivo. Pre-escolar masculino de cuatro años de edad quien ingresa por cuerpo extraño en vías aéreas (grano de maíz). Al estar hospitalizado presenta melenas con anemia e inestabilidad hemodinámica. Rectosigmoidoscopia con evidencia de sangrado descendente. Gammagrafía reporta zona de hipercaptación en ángulo esplénico de colon. En pabellón se realiza colonoscopia trans-operatoria, evidenciándose efusión sanguínea con puntillado hemorrágico en ángulo esplénico, por lo que se procede a realizar colectomía y anastomosis. Anatomía patológica reporta proliferación de vasos de mediano calibre en la submucosa, rodeados por estrona fibroso con infiltrado linfohistocitario, vasos congestivos en la serosa. Se plantea Lesión de Dieulafoy. Esta entidad clínica es infrecuente, el diagnóstico es difícil de realizar, cuando la ubicación es inusual. La gammagrafía es útil para el diagnóstico. Si el sangramiento digestivo compromete la vida del paciente el tratamiento definitivo es quirúrgico.

The Dieulafoy´s lesion is an infrequent but important cause of gastrointestinal haemorrhage. These lesions have been described at the gastric level and less frequently in the duodenum, jejune and colon. Macroscopically it is an arterial malformation, with tortuosity and elongation of the vessels that appear like a small defect in the mucosa and by histology as long vessels that surround the sub mucosa below the mucosa. It has an incidence of 0,3-1,5% as cause of massive gastrointestinal bleeding. 4 years old male that presents with a foreign body (corn seed) in the airway that required bronchoscophy. During admission presents frequent melena with anemia and hemodynamic instability. Rectosigmoidoscopy showed lower gastrointestinal bleeding without abnormal findings. Gammagram reported hypercaptant zone at the splenic angle of the colon. During surgery, trans-operating colonoscopy demonstrated hemorrhagic punctiform lesions with blood effusion at the splenic angle of the colon, and a segment of the colon was resected. Histopathology reported congestive blood vessels with proliferation of medium-caliber vessels, surrounded by fibrous stroma with linfohistiocitic infiltrate in the serosa, confirming the diagnose of Dieulafoy´s lesion. This is an infrequent cause of gastrointestinal bleeding that is difficult to diagnose when it presents in an inusual location. Gammagram is helpful for the diagnosis. If the gastrointestinal bleeding compromises the life of the patient, definite treatment should be surgical.

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Los tumores de ovario aunque son las neoplasias más frecuentes del tracto genital en la infancia representan menos del 5 por ciento de los tumores malignos en niñas y adolescentes. El objetivo de este trabajo es presentar el caso de una adolescente con tumor de ovario de células de la granulosa variedad juvenil por ser el primer caso que se presenta en el Instituto Autónomo Hospital Universitario de Los Andes. Los tumores de ovario de la granulosa se subdividen en dos tipos: variedad adulta más frecuente (95 por ciento) con pobre pronóstico y la variedad juvenil que ocurre en las tres primeras décadas de la vida, son hormonosecretantes y provocan pubertad pseudo precoz. En su diagnóstico, además de los exámenes paraclínicos e imagenológicos para tumor de ovario, se deben solicitar niveles séricos de esteroides, tanto como postoperatorio. Estos tumores son de pronóstico favorable y en su tratamiento sólo es necesaria la exéresis de la tumoración

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El divertículo uretral es una patología poco frecuente de etiología congénita o adquirida, se manifiesta de forma variable, el examen físico es primordial al momento de hacer diagnóstico y es de manejo quirúrgico. El objetivo del presente trabajo es exponer dos casos de diverticulo uretral que se han presentado en el Instituto Autónomo Hospital Universitario de Los Andes en los últimos años

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Los Linfangiomas son malformaciones congénitas benignas del sistema linfático, cuya etiopatogenia no está aún muy clara. Los higromas quisticos se presentan con mayor frecuencia a nivel del cuello. Se presenta el caso de una paciente con Higroma Quistico axilar por baja incidencia demostrada en dicha región, el tamaño de la lesión y la disyuntiva diagnóstica al ultrasonido prenatal

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La Técnica de Tnnison Randall original permite configurar el Arco de Cupido y calcular la altura labial, las modificaciones plantean restaurar la fisura alveolar, reconstruir el piso nasal y movilizar el ala nasal. Este trabajo fue realizado en el Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela, donde se utilizó la técnica modificada en 38 pacientes, desde 1995 al 2000. 87 por ciento de los pacientes fueron intervenidos en forma ambulatoria. El 71 por ciento eran de sexo masculino. 79 por ciento tenian labio hendido unilateral de éstos el 60 por ciento tenían de 5 a 8 meses de edad. Los pacientes con hendidura labial bilateral fueron intervenidos en dos tiempos: en el primero los de 5-12 meses y en el segundo de 9-16 meses de edad; el 87 por ciento no presentó complicaciones postoperatorias. En el 96 por ciento con labio hendido unilateral se logró la altura labial simétrica, el ancho total del labio, configuración del Arco de Cupido y cicatriz fina. En el 10 por ciento no fue adecuada la alineación cutáneo-mucosa, en el 73 por ciento fueron normales las características del bermellón, en el 63,3 por ciento se restauró la fisura alveolar; en el 76,7 por ciento se movilizó adecuadamente el ala nasal y en todos se logró la profundidad del vestíbulo bucal y alineación del músculo orbicular. El 8 casos de hendidura labial bilateral fue simétrica a la altura labial, en el 87,5 por ciento fue adecuado el ancho labial, el Arco de Cupido, la profundidad del vestibulo bucal, la alineación muscular y la restauración de la fisura alveolar; en el 62,5 por ciento se logró la cicatríz quirúrgica delgada, bermellón de aspecto normal y movilización parcial del ala nasal. Según los resultados obtenidos, la Técnica Tennison Randall modificada se puede realizar tanto en pacientes con hendidura labial inilateral y bilateral, pues cumple con los objetivos planteados desde del punto de vista estético y funcional

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La hendidura labio palatina es considerada como la malformación congénita más frecuente de la región facial. la finalidad de este estudio fue determinar su frecuencia en el estado Mérida durante el período 1991 al 2001, relacionándola con factores etiológicos, con el manejo y el establecimiento de programas de prevención. La investigación de tipo descriptivo y longitudinal se realizó en el Instituto Autónomo Hospitital Universitario de Los Andes. (IAHULA) en Mérida, Venezuela; se revisaron 302 historias clínicas y se tomaron 187 correspondientes a los pacientes menores de 14 años. Relacionándose con los nacidos vivos (nv) se obtuvo una tasa de 1.02 casos por cada 1000 nv. El 50,3 por ciento correspondió al sexo femenino, el 60,7 por ciento provenían de la zona agrícola y sólo 17,7 por ciento tenían antecedentes familiares portadores de la patología. El 66,8 por ciento de las madres se encontraban entre los 20 y 34 años de edad, predominando oficios del hogar en un 85 por ciento y el 63,7 por ciento de los padres eran agricultortes y obreros. Sólo el 23,6 por ciento de las madres enfermearon durante el embarazo. El 76,6 por ciento de los niños presentaban al nacer entre 2.501 y 3.500 gramos y sólo el 37,4 por ciento recibió lactancia materna. La hendidura con hendidura palatina fue mas frecuente (55 por ciento), 33 casos (17,4 por ciento) presentaron anomalías congénitas asociadas. Se realizó tratamiento ortopédico de maxilar al 54 por ciento de la población estudiada y 80,7 por ciento de los casos fueron intervenidos quirúrgicamente, la fístula palatina (28 por ciento) fue complocación postoperatoria más frecuente. En nustro estado la elevada incidencia presenta un problema de salud pública, por lo tanti es imperativo la elaboración de estrategias destinada a la prevención y el manejo integral de los niños con hendidura u labio palatina

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